At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

What is your go-to when you feel stressed out? Do you like a few glasses of wine, an hours long vent session, or a creative excuse to get out of a social engagement? These are all examples of experiential avoidance—an unwillingness to experience uncomfortable internal emotions or sensations and active efforts to change, reduce, or eliminate them (Forsyth and Eifert 1996). Does experiential avoidance work to alleviate feelings of stress? Yep. It works or we wouldn’t do it. But how long does that last? Look at your personal experience and take inventory:

1. what do you do or not do when you feel stressed?

2. what does it get you (i.e., what discomfort does it relieve)?

3. what is its cost?

When our reactions to stress result in only temporary relief but come at a cost to our health, our relationships, or other areas of importance, it’s time to reevaluate our relationship to stress.

Think of it this way (Stoddard, 2019): Imagine I have you in a little booth suspended above a barracuda tank. I tell you, “Whatever you do, don’t get stressed and you will be fine. Unfortunately, if you do feel stressed, the floor of the booth will open, dropping you into the barracuda tank. But just don’t get stressed and you will be totally fine!”

What do you think is going to happen? Right—you’re stressed…and fish food. Is it because you just didn’t try hard enough to control your stress? Was the incentive not quite high enough? Of course not—our most primitive instinct is to survive. So why did you get stressed and end up swimming with the fishes? Because when you are unwilling to experience stress, you are stressed about stressso you are stressed (Hayes, Strosahl, and Wilson 1999). See the trap? Your relationship to stress becomes one in which you evaluate it as bad, dangerous, and deadly.

So, of course, you are stressed about having stress.

So what should you do the next time you hear on Good Morning America or in the Huffington Post “Stress is bad for you! Stress will kill you! You shouldn’t get stressed!” It turns out, stress has been wrongfully getting a bad rap (McGonigal 2013). While stress does release adrenaline (the hormone thought to be harmful to the body), it also releases oxytocin, the bonding hormone that enhances empathy and motivates us to seek and give care. Oxytocin is a natural anti-inflammatory—it’s good for our bodies and actually strengthens our hearts. And, fascinatingly, all we have to do to mitigate the negative effects of adrenaline is simply appraise stress as helpful.

Come again? Stress, helpful? YES--stress can motivating! Stress is what prompts you to prepare for the important job interview, watch over your small children in a crowded place, and get ready for the big game. If you were totally chill, you’d likely bomb the interview, lose your kid at the mall, and blow the game. As it turns out, there is an optimal arousal zone when it comes to doing well (Yerkes and Dodson 1908): when stress is very high or very low, it has the potential to negatively impact performance. But a moderate level of arousal is helpful.

The best way to manage stress is simply to change your relationship to it. So stop struggling to avoid and reduce your stress (how’s that working for you, anyway?), and instead work on accepting that to be human is to know stress, and stress need not be our enemy. You can do that by remembering:

1. stress is motivating and can improve performance at moderate levels

2. stress prompts us to seek connection with others and this is good for our health

3. stress is only damaging when we evaluate it as damaging

4. when we are stressed about stress we are stressed

Now, don’t get me wrong—I’m not suggesting you give up your meditation practice because it makes you feel less stressed. There is nothing wrong with getting your bliss on—as long as your strategies don’t come at the cost of other meaningful and important pursuits. So go ahead and yoga-it-up—just don’t neglect your friends and family while you’re at it.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Forsyth, J. P., and G. H. Eifert. 1996. “The Language of Feeling and the Feeling of Anxiety: Contributions of the Behaviorisms Toward Understanding the Function-Altering Effects of Language.” The Psychological Record 46: 607–649.

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind.

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

One hundred years from now, America in 2017 will exist only in history books. Those future writers will have plenty of material to work with: mass shootings, terrorism fears, international turmoil, and “fake news.” But those facts probably won’t capture the anxiety that’s been generated by these events. A poll conducted earlier this year by the American Psychological Association found more than half of American adults cited the current political climate as a source of stress.

Children are feeling anxious too. A recent UCLA survey found that 51% of teachers reported more anxiety among their students. As a parent, the past year may have presented you with unique challenges as your children grappled with a range of emotions- from general anxiety to personal stress over the impact potential policies could have on them and their friends. You may have a child who’s finding that current events are causing anxiety, and are struggling to figure out how to best provide support.

As an adult, you might be experiencing negative feelings too, but you have the advantage of being able to channel them productively by contacting elected officials and engaging in activism and service. And you’re more likely to have developed meaningful ways to help yourself get through uncertain, difficult times. But your children might not be able to grasp the concepts that are troubling and confusing to them, and they may lack the skills they need to identify and cope with their feelings. Here are some ways to help them.

1. Listen, but accept that you might not always have good answers.

As a parent, you may be tempted to help by dismissing and downplaying the concerns and worries of your anxious child. But this approach, while well-intentioned, isn’t helpful. Validating kids’ concerns and making sure they understand that it’s ok to feel what they’re feeling is important. And unfortunately, you can’t magically erase the sources of stress for them. But you can be a sympathetic ear, and make a point to spend a little time each day talking to them about their concerns. Help them develop coping skills, which won’t eliminate the sources of negative feelings, but will help them learn to work through them. The ability to cope with challenging times is a necessary life skill.

2. Help them take action.

With so much beyond their control, your kids may find themselves feeling powerless. They might want to do something to distract them from their fears and help them feel like they’re contributing to the world in a positive way. Some adults are channeling their concerns into helping others, and there are ways children can do the same. Talk with them about some of the needs they observe in your community, and help them think of ways to address them. Young children can choose items from the grocery store to donate to a local food pantry, while older ones can join service-oriented local organizations, or look for a project to support, like a winter coat drive. Even small actions help students feel like they matter, and lead to a life-long involvement with community service.

3. Connect with the school counselor.

Kids spend a substantial amount of time in school, and their counselors are a valuable resource. School counselors are already trained to help students learn to manage a wide range of situations and challenges. And they’ve got ample materials to help them work with students who are living with political anxiety. Last year the American School Counselor Association published a guide for counselors, with suggestions for supporting children experiencing post-election stress. Sitting down with a school counselor could be a great opportunity for your child to share his or her fears with a trained professional. Ask for ideas and strategies to use at home to talk about current events, and the feelings these events generate.

4. Examine the impact of technology.

News and social media might play a role in fostering negative feelings. Escaping bad news used to be as easy as turning off the television and radio. Now, with 24-hour cable channels, mobile apps, and social media, it’s almost impossible to get a break from current events. Consider the role screen time with televisions and gadgets may be playing in your child’s politics-related stress. Evaluate the amount of time your child spends watching and reading news, and discuss alternative activities which may help them manage their stress.

5. Talk about previous times our country experienced turmoil and got through it.

It feels like we’re going through unprecedented uncertainty, but America has faced crisis before, more than once. Our country has survived wars, recessions, and natural disasters. Your children likely have some awareness of challenging times in our history, but events of long ago probably feel abstract to them; they may not be able to connect past and present. Depending on your age, you may have your own personal stories to share which might resonate with your anxious children and help them feel more optimistic. For example, during the 1970s, Watergate dominated the news, and led to concerns about government. In the 1980s, the Cold War between the United States and the former Soviet Union generated fears as both countries and their allies engaged in an arms race, generating legitimate concerns over the possibility of nuclear war. Share your stories and take this opportunity to talk with your kids about America’s resilience.

Providing support for anxious kids is challenging, but it is possible. As a parent, you know your child better than anyone, and are the best person to help them manage stress and anxiety. However, if you need some outside support to help your child, you can check your child’s school for resources, and reach out to outside resources, like local therapists, as well.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Therapy can be incredibly helpful and healing in the midst of struggle, but it’s not “one size fits all” and sometimes it can be challenging to find the right fit. If you have tried therapy before and been frustrated by a lack of progress, it’s possible you haven’t found the right therapist for you. Having some knowledge about therapy and the different options available can help when you are seeking out help.

What do therapists do?

A therapist’s role is to provide you with empathy, help you learn healthy coping methods and give you tools to manage your emotions constructively. They are there to help you connect with your personal values and get in touch with your own internal strength, while offering you compassionate support and understanding along the way. They are like “training wheels” to help you learn to engage in life in a new way.

What don’t therapists do?

They are not there to pass judgement, minimize your feelings, or offer you advice. No advice means that they are not there to make decisions for you, such as whether or not to stay in a relationship or a job; they can, however, assign you homework to help you make progress and teach you coping mechanisms.

If you ever feel judged or like your therapist is minimizing your feelings, discuss this with them. This will allow you to discern whether you misunderstood their message or whether maybe they are not the best fit for you. It is important to talk with your therapist about the therapeutic process itself, especially if something feels off.

Note: therapy can be helpful and it can be hard.

Therapy is challenging. It requires active work on the part of the client and it requires facing uncomfortable and painful emotions, and likely making difficult changes. As James Hollis (1998) notes, “no one enters the therapist’s office whose adaptive strategies are still working.” So sometimes, clients may feel worse before they feel better because change is inherently uncomfortable. This kind of “feeling worse” is a vital part of the growth process, not a further descent into the same struggle that brought you into the office.

If it feels like you have tried various therapies or therapists, and have not progressed despite your commitment to finding help and engaging in the therapeutic process, you may not have found the right therapist yet. Here are some things to look for when seeking therapy.

Connection with the therapist. Therapy requires that you let another person in on your innermost thoughts and feelings. This is not an easy thing to do, so it is important that you feel comfortable with the person you choose. Research shows that the therapeutic relationship itself is the most important aspect of therapy – accounting for about 30% of the variance in treatment outcome, which is more than any other factor including the technique the therapist uses. So make sure that the therapist you choose to see is someone you trust and whom you are willing to talk to. If it doesn’t feel like the right fit, it probably won’t be.

The therapist’s areas of expertise. While the relationship is the most important piece of therapy, specialization and technique are still very important pieces of the puzzle. When looking for a therapist, make sure to search for someone who has experience working with individuals dealing with your particular concerns. Otherwise, you may end up wasting time and money working with someone who might not conduct a proper assessment, or who does not have experience working with your particular issue. Ask them about their experience working with others who have concerns similar to yours, including the techniques they use and the degree of progress and healing that they typically see in their clients.

Evidence based treatments. There are lots of different treatment options out there; a good place to start is searching for a therapist with true training in modalities that are supported by solid research (such as Cognitive Behavioral Therapy or Acceptance and Commitment Therapy). Ask questions about their training and choice treatment modalities, what a typical session will look like, how your individual needs will be addressed, whether you will receive homework, what will be required of you in the process, how your progress will be evaluated, and what steps will your therapist take if they find that your progress has prematurely plateaued.

If you are struggling and considering reaching out for help, this knowledge can help you navigate choosing a therapist and can help you recognize sooner rather than later if it’s not the right fit. If you have tried therapy before and have been frustrated by a lack of progress, you are not alone. Remember, effective help is available when you know what to look for.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com

There seems to be an app for everything these days. Smartphones have become like little pocket genies – your wish is its command. Whether you want a date, a ride, or help with a physical or mental health concern, your smartphone claims to have you covered.

Recently, there has been a surge in apps claiming to help calm anxiety. Some offer mood tracking, others offer guided breathing and meditation, still others allow you to track your thoughts, claiming to utilize CBT methods to help you reframe unhelpful ideas. While technology can be a powerful tool, it’s important to think critically about how we use it and the effect it can have before we rely on it too heavily.

What does the data say about anxiety apps?

Depression and Anxiety: The official journal of the ADAA recently published a study conducted to assess commercially available anxiety apps. Researchers analyzed 52 anxiety/worry relief apps that purportedly use psychological techniques. They discovered that 67.3% of the apps were developed without any input from a healthcare professional, and only 3.8% of them had been rigorously tested.

So the people developing anxiety apps may not actually know much about anxiety, and they almost certainly don’t know if their app will really help you.

Authors of the study concluded that while apps have the potential to broaden access to mental health resources, there is currently a major lack of data regarding the efficacy and effectiveness of the available options. As such, the application space has yet to reach its full potential in helping people with anxiety.

What if an anxiety app is helping me?

Of course, the issue here is a lack of data. You may have found an anxiety app that does help you to manage your worry throughout the day. Guided meditations, breathing exercises, and journaling our thoughts and feelings can certainly be useful.

Should I ask Siri or a professional?

However, an app does not replace professional treatment. If you are dealing with anxiety that is impairing your ability to function in your day to day life, it’s important to seek professional guidance.

Human connection is important for our mental health.

Furthermore, while apps may one day prove to be a useful anxiety management tool, they will never replace the human connection that takes place in the context of therapy. In fact, it is actually the therapeutic relationship itself that is the most important aspect of therapy – it accounts for around 30% of the variance in treatment outcome, which is significantly more than any other factor, including the specific techniques used by the therapist (like CBT or mindfulness). This means that who your therapist is, how you relate to them, and the relationship you share is the most helpful part of therapy. An app will never be able to offer this relationship.

Technology may help us manage anxiety, but it may also be a source of anxiety.

Finally, when considering anxiety apps, it is important to note that according to the APA, smartphone use has been linked to higher stress levels, particularly in those who check their phones constantly.

Given the rapid development of technology and its ever broadening influence in our lives, it is important that we stay curious and aware of the potential it has to both help and hinder us, particularly when it comes to something as important as our mental health.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Whether or not you struggle with an anxiety disorder, we have all found ourselves overwhelmed by stress or anxiety at some point. We each have slightly different stressors that trigger our body’s natural stress response, but we all know what the response feels like: sweaty palms, racing heart, tense muscles. This bodily reaction can feel overwhelming, as if it controls us. It is easy to feel powerless to our biological response to stress, but we have more control than we think.

THE STRESS RESPONSE

Before we deem our biological reaction to stress bad, let’s talk about what happens and what purpose it serves. When we get stressed out or anxious, our body begins preparing us to face threat. Stress activates our sympathetic nervous system, triggering the fight-flight-or-freeze response. This causes the sweaty palms, racing heart, panicky breathing and muscle tension (McGonigal, 2013). We often look at the stress response as inherently bad, because it is not healthy to be in the fight-flight-or-freeze mode chronically (McGonigal, 2013). However, it’s important to remember that when your heart starts racing or your palms get sweaty, your body is just trying to help prepare you. Nevertheless, these sensations can feel overwhelming, and perpetuate our experience of anxiety. So how can we calm ourselves down once this cycle is in motion?

DEEP BELLY BREATHING

Using our breath, we actually have the power to activate our parasympathetic nervous system. The parasympathetic nervous system allows our body to “rest and digest” as opposed to the sympathetic nervous system’s fight or flight response (Hunt, 2016). While “take a deep breath” is common advice, how we actually take that breath is important. This is how to use the breath to calm down:

Find a comfortable, relaxed seated position with your feet planted on the ground; alternatively, you can try breathing laying down. Now begin to bring your focus to your breath.

With each breath, your belly should rise as you inhale and fall as you exhale.

Your shoulders and chest should remain still. If you notice your shoulders rise, or your chest move, drop the breath down to the belly. Breathing into your chest is reminiscent of hyperventilating, which will only further activate your sympathetic nervous system (Hunt, 2016).

Now focus on breathing into your belly for four counts. Hold your breath for a second or two. Now exhale for five counts and relax (Hunt, 2016). Repeat this process, focusing on your inhalations and exhalations, and making your belly rise and fall.

You may notice that your heart rate speeds up at first. Don’t panic or give up. Your body is not used to calming itself down, and is simply adjusting. After a few cycles of inhaling and exhaling, you should notice your heart rate begin to relax.

If you begin to get distracted or thoughts pop into your mind, simply notice they are there and then come back to focus on the breath.

See if you can practice doing four or five deep belly breaths a day. Then see if you can work your way up to thirty seconds at a time. Then maybe a minute. Eventually, you will be able to sit in this space with your breath for a long period of time.

Being able to tap into your breath to find a calm, centered space, no matter where you are, is an invaluable resource. This diaphragmatic breathing essentially turns off your sympathetic nervous system and turns on your parasympathetic nervous system (Hunt, 2016).

This is not to say that you will never feel stressed again, or that you will never experience the fight-flight-or-freeze response. But using deep belly breathing can help you to calm your body down and lessen the biological reaction to a stressful situation.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.